The application of the concept of total quality management in hospitals has been found to improve the performance of healthcare providers namely nurses. From this ideology, nurses have the opportunity to exercise their stewardship and competence ability as they conduct their day-to-day duties and responsibilities. The technique of total quality management poses an intriguing and thought-provoking approach to the traditional methodologies of management. The striking difference that can easily be accessed in the total quality management is the management mode which is more participatory unlike in the conventional system. It is quite often considered to be shrewder and highly effective.
Nurses have a myriad of benefits when their service delivery standard which is often assessed within the leadership hierarchy of an organization is substituted by the performance merit of each individual nursing staff. The likely advantages that can be accrued from the total quality management rely heavily on the structure of the healthcare unit and individual dedication to the job description. This paper attempts to explore the role played by nursing in Total Quality Management (TQM).
Role of nursing in Management
There has been major reform in the healthcare system since the 1980s. Medical experts have been the main target in these reforms bearing in mind that massive challenges continue to abound in the healthcare sector in terms of complexity in disease treatment. Moreover, the nursing fraternity has faced a total overhaul in its administrative composition and competence (King, 1987). Therefore, one of the areas of interest in which nursing can contribute to significant total quality management is in the mode and fashion of its administration (McLaughlin & Kaluzny, 1990). Despite the government neglecting that nursing might be experienced all over the world, they still have the noble responsibility of administering the production, distribution, and allocation of the meager resources at their disposal. As a result, nursing has a role of identifying the deserving and urgent areas of need within a healthcare organization and then drawing a comprehensive scale of preferences number of recommendations on how nursing can exercise stringent control in its management practice are available. For instance, there should be separate operating divisions that handle purchases and caregiving within a healthcare organization (Fredenburg, 1988). This is imperative because it would ensure a clear-cut division of labor and limit the duplication of roles and duties. In addition, independently operating divisions within a healthcare set-up will abet the possibility of under-performing or inefficiency in service delivery.
Another strategy that can be developed towards attaining total quality management is to allow a contracting procedure through an open tendering process for an institution’s supplies. Through this system, the basic and most significant role of nursing will be enhanced and promoted. A more dramatic step of creating autonomous trusts within the healthcare units can equally generate more managerial benefits to the nursing fraternity than sticking to the conventional styles of management. In the case of general healthcare practitioners, some similar if not related policies should be enacted. A case in point is the pooling and segregation of some budgetary funds to be utilized in cases of emergencies.
The nursing management is also mandated to craft a holistic patient charter record where personal views and opinions from the visiting or admitted patients can address their complaints or compliments in regard to the nursing care offered. Some of the elements that can be included in this charter book record include waiting for durations before patients are attended to, the receptive and caring attitude of the nurses as well as the overall state of healthcare delivery standards in the organization. The obtained data can be used as an appraisal sheet which may aptly be made use of in-service delivery improvement mission.
Managers have a terse role of comprehending and interpreting the “difference between total quality and continuous quality…and the difference between quality theory and management theory” (Berwick, 1989). Developing such an understanding will help them adopt working and valid strategies. In retrospect, total quality long-fetched concept based on the statistical approach and which currently enjoys wide-based mechanisms aimed at improving the performance of healthcare organizations. On the other hand, management theory tackles a variety of academic concepts. Managers should be able to appreciate the fact that a hybrid system obtained when these two ideologies intermingle is what defines effective and efficient management. It is inevitable that both total quality management and quality theory are needed in a healthcare institution for efficient service delivery. This should form a pragmatic lesson for nursing managers because it will explicitly map out the distinction between good and bad managerial skills. After this evaluation, managers can take a decisive step of either working towards eliminating the current and foreseeable constraints to healthcare providers or generally improvin the healthcare delivery to their prospective patients.
Nursing managers have the responsibility of undertaking radical changes from radical proposals as a step towards total quality management. For example, it may not be advisable to run two parallel quality assurance departments within a single healthcare unit. Both the duplication of duty as well as high operational costs is more likely to pose some serious challenge (Berwick, 1989). Such departments in a healthcare organization that seem to deliver more or less the same services ought to be scrapped off and eventually merged as a measure of cutting down costs and enhancing efficiency. In spite of the hospital size and the bulk of patient inflow and outflow, multiple parallel divisions should be permitted at all costs.
In addition to the above measures, nursing managers will still have the role of inculcating new and more rigorous performance targets to all the nursing staff under their jurisdiction. In achieving this, new goals and objectives have to be set against specific time frames within which they should be achieved. Monthly reports regarding patient feedbacks on service delivered should also be reviewed regularly to establish, rectify, cement, and connect the missing links.
The list of radical reforms should include reformatting “the newsletter to include a ‘CEOs Update column’ that report the hospital’s performance…” (King, 1987). This may also entail any other important events for that particular month. Of utmost importance and which the nursing manager cannot afford to ignore is the welfare and well-being of the healthcare employees (McLaughlin & Kaluzny, 1990). A survey detailing the contentment level of workers for a given period of time should be considered. After a careful analysis of the presented information, the manager should take it as an opportunity to provide the necessary resources which will on the other hand motivate the working staff to deliver the best.
Total Quality Management (TQM) is a very viable tool that can be used by the nursing fraternity to provide effective and efficient healthcare services to patients. Contrary to the conventional nursing practices, TQM ensures effective management of resources through an open tendering and contracting system and it is also more participatory. The nursing manager has the responsibility of monitoring, analyzing, and disseminating the right judgment pertaining to the successful management of a healthcare institution.
Berwick D.M. (1989). Continuous improvement as an ideal in health care. N Engl J Med. 320(1):53–56.
Fredenburg A.M. (1988). Quality assurance: establishing a program for libraries. Spec Libr. Fall; 79(4):277–284.
King D.N. (1987).The contribution of hospital library information services to clinical care: a study in eight hospitals. Bull Med Libr Assoc. 75(4):291–301
McLaughlin C.P and Kaluzny A.D. (1990). Total quality management in health: making it work. Health Care Manage Rev. Summer; 15(3):7–14.